Hospital Surge, Exercises and Pandemics
by DemFromCT
Sun Apr 13, 2008 at 08:01:00 AM PDT
Have you ever participated in a school fire drill? If you have, you've been part of a live disaster exercise. And like fire drills, the health system (including hospitals and public health) need to run their own drills to see what works and what needs to be done better so as to be better able to handle a natural disaster like the California wildfires or a pandemic. We ran an interesting drill last weekend to practice how my local area would respond to an influenza pandemic.
Part of the the health reform task is to make sure that natural disasters such as hurricanes, wildfires and (yes) influenza pandemics can be approached and mitigated by improving medical and public health infrastructure. One way to do this is to examine and improve the ability of hospitals to care for an excess number of patients for at least short periods of time. However, this can lead to concern about playing the fear card, and overdoing response. Despite those concerns, there's need to plan for surge.
California has led the way, with careful definitions:
A healthcare surge is proclaimed in a local jurisdiction when an authorized local official, such as a local health officer or other appropriate designee,3 using professional judgment determines, subsequent to a significant emergency or circumstances, that the healthcare delivery system has been impacted, resulting in an excess in demand over capacity in hospitals, long-term care facilities, community care clinics, public health departments, other primary and secondary care providers, resources and/or emergency medical services. The local health official uses the situation assessment information provided from the healthcare delivery system partners to determine overall local jurisdiction/Operational Area medical and health status.
Healthcare surge is not the frequent emergency department overcrowding experienced by healthcare facilities (for example, Friday/Saturday night emergencies). It is also not a local casualty emergency that might overcrowd nearby facilities but have little to no impact on the overall healthcare delivery system.
As defined above, a healthcare surge will directly impact a provider's ability to acquire and manage resources under their normal procedures.
This means that during times of stress to the system, usual standards of care will need to be switched to what's called 'essential care', the provision of which will mean different standards than what the public is used to.
An influenza pandemic is an example of the type of natural disaster that would require health care surge. As an update of where we are at with H5N1 and bird flu, try this piece from the Times (UK):
It is now five years since the present outbreak of H5N1 avian flu first infected people. Though 379 people have since contracted the virus, of whom 239 have died, it has yet to start a pandemic.
As its name suggests, bird flu remains predominantly an avian disease. While it is very dangerous to humans who catch it, this has happened only rarely, after close contact with infected birds.
This week, however, brought some alarming news. Writing in The Lancet, a Chinese medical team confirmed that a 52-year-old man who contracted H5N1 in Jiangsu province last December almost certainly caught it from his 24-year-old son, who died. It is the best-documented case of human-to-human transmission to date.
That is important because, if this virus is going to start a pandemic, it must first acquire the ability to move readily from person to person. Not enough people are ever going to catch it from birds to constitute a global threat. The Chinese case, like a previous suspected human-to-human incident in Thailand, has thus raised fears that H5N1 might be mutating in worrying fashion, and it was duly reported around the world.
The details of the Lancet study, however, are less troubling than they at first appear. This investigation of this cluster of infections, indeed, is somewhat reassuring because of what it shows has not happened.
It has not become easier to catch, and human-to-human (H2H) transmission remains rare - but not unknown. Similar H2H spread was also documented in Pakistan last year, in a case that involved a family member traveling to the United States. But whether the next pandemic is H5N1 or some other virus, pandemics are inevitable. Since it's not a matter of "if", but "when", planning has to occur to cover the areas where we will be short. In other words, since 20-30% of the public will be ill, pandemics will cause the health system to run short of staff, space and stuff... the exact things that surge tries to alleviate.
There's only one problem... no matter how hard you try, you'll still run short. And for that reason, even creative solutions will need to be coupled with unpleasantry in the form of rationing. Whether it's rationing of space or of resources, triage of pateints will be an inevitable consequence of too many ill and not enough resources.
More on the flip...
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